SignificanceNeurosurgical fluorescence imaging is a well-established clinical approach with a growing range of indications for use. However, this technology lacks effective phantom-based tools for development, performance testing, and clinician training.AimOur primary aim was to develop and evaluate 3D-printed phantoms capable of optically and morphologically simulating neurovasculature under fluorescence angiography.ApproachVolumetric digital maps of the circle of Willis with basilar and posterior communicator artery aneurysms, along with surrounding cerebral tissue, were generated. Phantoms were fabricated with a stereolithography printer using custom photopolymer composites, then visualized under white light and near-infrared fluorescence imaging.ResultsFeature sizes of printed components were found to be within 13% of digital models. Phantoms exhibited realistic optical properties and convincingly recapitulated fluorescence angiography scenes.ConclusionsMethods identified in this study can facilitate the development of realistic phantoms as powerful new tools for fluorescence imaging.
We have optimized our prior phantom-based test method for cerebral oximetry performance using a new 3D-printed cerebrovascular module (CVM). In addition, we have and added a surrogate for a thin perfused scalp layer to evaluate perfusion- related confounding factors. The new CVM’s optical properties better represented biological tissue and also incorporated a water-mimicking dye. The modular phantom also included biologically relevant scalp/skull and cerebrospinal fluid (CSF) layers. Performance testing of two commercially available clinical oximeters with the modified CVM over a range of oxygen saturation levels illustrates the utility of our solid phantom-based approach for standardized cerebral oximeter performance assessment.
Cerebral oximetry based on near-infrared spectroscopy (NIRS) has seen increasing clinical use for monitoring of premature infants as well as during neonatal, pediatric and adult cardiac surgery. One key confounding factor and a likely contributor to observed inconsistency amongst commercial NIRS oximeters is skin pigmentation. Clinical studies have shown negative bias in oxygen saturation (StO2) with increasing melanin content. In prior work, we developed a cerebral oximetry phantom comprised of a 3D-printed channel array module representing brain tissue and molded silicone layers simulating extracranial regions. The purpose of the current study was to develop and test epidermis-simulating layers that exhibit realistic human pigmentation properties. Initially, we performed spectroscopic characterization of potential melanin simulating agents – including coffee, India ink, synthetic melanin, and water-soluble nigrosin – in a polydimethylsiloxane (PDMS) substrate. We determined that the NIR absorption spectrum of water-soluble nigrosin most accurately matched human melanin. Layers of 0.1 mm thickness were fabricated with different nigrosin concentrations to simulate epidermis with light, moderate, and dark pigmentation. The brain module channels were filled with bovine blood in the 30-100% oxygenation range and measurements performed with neonatal/pediatric probes from commercially available cerebral oximeters. We found that StO2 reported by the oximeters decreased monotonically with increasing pigmentation level. The magnitude of this impact increased with decreasing StO2, producing a maximum change in saturation of approximately 8%. The consistency of our results with prior clinical findings provides preliminary evidence of the utility of our approach for assessing the impact of epidermal melanin in phantom-based performance testing.
Point-of-care technologies have become increasingly important in diagnostic applications. Wireless capabilities provide easy storage and analysis of data. Thus, portable systems need to migrate to handheld versions. Previously we have been able to determine blood volume fraction and water content in human skin using near-infrared (NIR) imaging. We have also used this portable multispectral imager to successfully identify remission of disease after treatment in patients with Cushing disease. Here we present a handheld high resolution multispectral imager. This tool is designed to be light weight and easy to use to promote its use in any clinical setup. The device consists of a custom fabricated CMOS imaging camera with on-chip NIR filters, a 25mm lens and wireless communication electronics. Illumination is provided by a broad band incandescent lamp. The use of novel technology of on-chip filters avoids the need for large size filtering systems such as filter wheels, making it a handheld device. Eight NIR filters with wavelengths in the range 700 nm to 980 nm provide flexibility of detecting multiple chromophores in the skin such as oxy and deoxy hemoglobin, melanin etc. as well as water. Images are acquired simultaneously with exposure time of 300 ms to 500 ms. Each filtered image is about 340X340 pixel making it possible to use our curvature correction algorithm for accurate determination of parameters. Also, images at this resolution can provide reliable information about spatial variations. This tool can ultimately be used to the study other skin abnormalities such as Kaposi Sarcoma.
Clinical cerebral oximeters based on near-infrared spectroscopy (NIRS) are a commonly used, non-invasive tool for intraoperative monitoring of hemoglobin saturation. Research to verify performance of cerebral oximeters in human subject trials has shown differences between commercially available devices. Test methods based on tissue-simulating phantoms have been proposed to augment clinical findings. While prior studies have focused on liquid phantoms, this work is aimed at developing methods based on solid polymer phantoms that are stable. Specifically, we have designed and fabricated a neonatal/pediatric head mimicking layered phantoms based on a 3D-printed cerebral matrix incorporating an array of vessel-simulating linear channels. Superficial layers incorporating homogeneous molded polydimethylsiloxane (PDMS) slabs were fabricated to represent CSF, scalp and skull regions. The cerebral matrix was filled with bovine blood desaturated with sodium dithionite to achieve oxygenation levels across the 40-90% range. Measurements were performed with a commercially available cerebral oximeter using two probes with different illumination-collection geometries, as designed for neonatal and pediatric patients. Reference measurements of samples were performed with a CO-oximeter before injection and after extraction. Results from applied cerebral oximeters indicate a strong sensitivity to the thickness of the superficial layer of the phantom. Better correlation with the reference CO-oximeter results were obtained in the superficial layer thickness of 0.8-2.5 mm range. Channel array phantoms with modular superficial layers represent a promising approach for performance testing of NIRS-based cerebral oximeters.
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